Aubf Flashcards
What are the urinary system
Kidney
Ureter
Bladder
Urethra
where urine is formed by FILTRATION of
blood
Kidney
carry the urine to the bladder
Ureter
stores the urine produced
Bladder
delivers the urine for EXCRETION
Urethra
Major function of kidney is the ___________ of ________; Urinary system is also called _________________
Filtration of blood; excretory system
Kidney’s function:
Mainting homeostasis
Excretion of waste product
Maintaing blood pressure
is the production of RBCs.
Erythropoeisis
is mainly released by the kidneys
Erythropoeitin
If the kidney is damaged, there is low _________ and ___________
Hemocratic and hemoglobin
The functional unit of the kidney; Approximately __________________ each kidney
Nephron; 1 to 1.5 million
is basically connected to the ability of the kidney to clear waste products
Nephron
Low blood production can lead to __________
blood transfusion
Parts of nephron
Glomerulus/renal corpucles (capillary tuft)
Bowman’s capsule
Proximal convoluted tubular
Loop of henle (ascending/descending)
Distal convoluted tubular
Afferent arteriole (portal of entry/ unfiltered)
Efferent arteriole (portal of exit / filtered)
Peritubular capillary (proximal and distal convoluted tubular)
Vasa recta (ascending/descending)
_______________ and ________________ are maintained which is controlled by nephrons
Body’s essential water and electrolyte balance
as blood flows into each nephron, it will enter a tiny blood vessel (glomerulus)
Glomerulus
participates in the filtration of
blood from glomerular capillaries
Bowman’s capsule
reabsorption happens here; give the reabsoption materials that are included:
Proximal convoluted tubular; sugar, sodium chloride, ions and water
principle function is mainly involved with the recovery of water and sodium chloride from the urine
Loop of henle
regulates extracellular fluid and maintain
electrolyte homeostasis
Distal convoluted tubular
provide immediate reabsorption of essential substances from the fluid.
In here, the final adjustments happen when it comes to urinary composition.
Peritubular capillary
major exchange of water and salt takes place in line with this particular area of____________, maintains the ____________ or __________ concentration of urine
Vasa recta; concentration or gradient
2 types of nephron
Cortical nephron
Juxtamedullary
Approximately ____________; Responsible for removal of waste products reabsorption
Cortical nephron; 85%
Approximately __________ ; Primary function
concentration of the urine
Juxtamedullary nephron
4 Renal function
Renal blood flow
Glomerular filter
Tubular reabsorption
Tubular secretion
The ___________ receive a large blood flow (25%); what renal function is responsible to this
Renal blood flow; kidney
Renal blood flow : ______________ supplies blood to the kidney.
RENAL ARTERY
Based on of average body size of ________ in terms of renal blood flow
1.73m^2
TOTAL RENAL BLOOD FLOW:
1200 mL/min
TOTAL RENAL PLASMA FLOW:
600 to 700 mL/min
Served as a sieve or a filter of plasma substances with molecular weight of __________
Glomerulus : less than 70,000
Glomerulus Consists of coil of approx. _____________ referred to as _________
eight capillary lobes ; capillary tuft
Glomerulus Located within the _______________(forms the beginning of the renal tubule)
BOWMAN S CAPSULE
In glomerular pressure has presence of ___________ (cause by size of afferent and efferent arteriole)
Hydrostatic pressure
are necessary to overcome the opposition of pressure from the fluid from the Bowman“s capsule and the ONCOTIC PRESSURE of unfiltered plasma protein
Hydrostatic pressure
This system respond to changes in blood pressure and plasma sodium content
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM (RAAS)
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM (RAAS) monitored by
JUXTAGLOMERULAR APPARATUS
is an enzyme which is mainly produced by the________________ cells.
Renin; Juxtamedullary cells
FUNCTION OF ANGIOTENSIN II
Vasolidation
Stimulate sodium
Release hormone aldosterone
Release antidiuretic hormone
Wha are the 2 mechanism of reabsorption
Active transport
Passive transport
Substance to be reabsorbed must combine to a carrier protein contained in the membranes of the ________________
Active transport; renal tubular cells.
Can be influenced by the concentration of the substance being transported.
Active transport
plasma concentration at which active transport stops.
Renal threshold
movement of molecules across membrane as a result of differences in their concentration or electrical potential.
Passive transport
Exceeding the renal threshold of substances affects the Maximal reabsorptive capacity of the tubules, leading to the appearance of the substance in the urine
Passive transport
Active transport
Substances:
Location: proximal convoluted tubule
Glucose
Amino acid
Salts
Active transport
Substances: glucose, amino acid and salt
Location:
proximal convoluted tubule
Active transport
Substances: sodium
Location:
Proximal and distal convoluted tubule
Active transport
Substances:
Location: Proximal and distal convoluted tubule
Sodium
Passive transport
Substance: water
Location:
Pct
Descending loop of henle
Collecting duct
Passive transport
Substance:
Location: Pct, Descending loop of henle, Collecting duct
Water
Passive transport
Substance:
Location: Pct, ascending loop of henle
Urea
Passive transport
Substance: urea
Location:
Pct, ascending loop of henle
Passive transport
Substance:
Location: ascending loop of henle
Sodium
Passive transport
Substance: sodium
Location:
ascending loop of henle
Begins in the descending and ascending Loop of Henle
Tubular concentration
COLLECTING DUCT CONCENTRATION
- Depends on the osmotic gradient in the medulla and the hormone VASOPRESSIN (ADH)
- Production of vasopressin is determined by the state of body hydration
is an anti-diuretic hormone involve in water reabsorption.
Vasopressin
is removed by osmosis in the descending loop of Henle, and sodium and chloride are reabsorbed in the ascending loop
Water
Dilation of the afferent arterioles and constriction of the
efferent arterioles
BP drops
Body hydration: high
Adh: low
Urine volume:
High
Body hydration: high
Adh:
Urine volume: high
Low
Body hydration:
Adh: low
Urine volume: high
High
Body hydration: low
Adh:
Urine volume: low
High
Body hydration:
Adh: high
Urine volume: low
Low
Body hydration: low
Adh: high
Urine volume:
Low
2 MAJOR FUNCTIONS: tubular secretion
- Elimination of waste products not filtered by the glomerulus (Ex.Urea&Medications)
- Regulation of acid- base balance (secretion of hydrogen ions)
ACTS AS BUFFER TO THE BLOOD MAINTAINING NORMAL pH.
BICARBONATE
Measure the filtering capacity of the glomeruli. And the rate at which the kidneys are able to remove (to clear) a filterable substance from the blood.
Clearance test
The substance analyzed must be one that is neither reabsorbed nor secreted by the tubules.
Clearance test
Clearance test Stability of substance in urine during _________________
24- hour urine collection
Clearance test Reported in what unit
mL/min
STANDARD METHOD for GFR and it Demonstrate progression of renal
disease or response to therapy
Urea clearance test
Not give reliable estimates of GFR
(Approximately 40% of filtered urea is
reabsorbed) and It is about 50% of creatinine clearance.
Urea clearance test
REFERENCE METHOD for GFR and Not routinely done because of the necessity for
continuous IV infusion
Insulin clearance test
insulin clearance test PRIMING DOSE:
25mL of 10% insulin solution
Insulin clearance test CONTINUOUS INFUSION:
500mL of 1.5% insulin solution
REFERENCE VALUES: insulin clearance test
Male:
Female:
Male: 127mL/min
Female: 118mL/min
Most commonly used; screening method of GFR and waste product of muscle metabolism
Creatinine clearance
Excellent measurement of renal function
Creatinine clearance
is freely filtered by the
glomerulus but not reabsorbed.
Creatinine
A measure of the completeness of a 24 hour urine collection.
Creatinine clearance
REFERENCE VALUES: creatinine clearance
Male:
Female:
Male: 85-125mL/min
Female: 75-112 mL/min
Determines the functional capacity of nephrons
Glomerular filtration rate
Determines the extent of nephron damage in known cases of renal disease.
◦ Monitor the effectiveness of treatment
◦ Determines the feasibility of administering medications
Creatinine clearance
Disadvantage of CCT:
◦ Some Creatinine is secreted by tubule
◦ Chromogens present in human plasma
◦ Some medications causes false decreased
value
◦ Creatinine breakdown by some bacteria
◦ influenced by heavy diet
◦ Interference by muscle wasting disease.
Disadvantage of CCT:
◦ Some Creatinine is secreted by tubule
◦ Chromogens present in human plasma
◦ Some medications causes false decreased
value
◦ Creatinine breakdown by some bacteria
◦ influenced by heavy diet
◦ Interference by muscle wasting disease.
◦ Indirect estimate of GFR
◦ A low molecular weight protease inhibitor
◦ Completely reabsorbed by the PCT, hence its
presence in urine denotes damage to the tubules
◦ good procedure for screening and monitoring
GFR.
Cystatin C
Cystatin C
Specimen:
Increased levels:
Method:
SPECIMEN: Serum or plasma (fasting is not required
INCREASED LEVELS: Acute & Chronic Renal failure, Diabetic nephropathy
METHOD: Immunoassay
Dissociates from human leukocyte antigens at constant rate and is rapidly removed from the plasma by glomerular filtration.
◦ A rise has been shown to be more sensitive indicator of decrease in GFR than creatinine clearance.
◦ Not reliable in patients who have history of immunologic disorders.
Beta 2 microglobulin
Dissociates from human leukocyte antigens at constant rate and is rapidly removed from the plasma by glomerular filtration.
◦ A rise has been shown to be more sensitive indicator of decrease in GFR than creatinine clearance.
◦ Not reliable in patients who have history of immunologic disorders.
Beta 2 microglobulin
- used for routinely screening patients as part of a metabolic profile
- to monitor patients already diagnosed with renal disease or at risk for renal disease.
- the formulas are valuable when medications that require adequate renal clearance need to be prescribed.
Estimated Glomerular Filtration Rates (eGFR)
- used for routinely screening patients as part of a metabolic profile
- to monitor patients already diagnosed with renal disease or at risk for renal disease.
- the formulas are valuable when medications that require adequate renal clearance need to be prescribed.
Estimated Glomerular Filtration Rates (eGFR)
Ability of the tubules to reabsorb the essential salts and water that have been nonselectively filtered by glomerulus
Concentration test
Concentration test The specific gravity of urine before entering the renal tubules is________
1.010
2 specific gravity test
Fishberg test
Mosenthal test
Patients were deprived of fluids for 24 hours prior to measuring specific gravity
Fishberg test
Compare the volume and specific gravity of urine of day and night urine samples
Mosenthal test
measures only the number of particles in a solution, specific gravity is influenced by the number and
density (molecular weight) of the particles.
Osmolality
is performed for a more accurate evaluation of renal concentrating ability.
Osmolality
FREEZING POINT OSMOMETERS
Principle:
Standard reference:
Principle: Measurement of freezing point depression
Standard reference: NaCl
Temperature at which water and ice are in equilibrium and is related to solute concentration
Freezing point
VAPOR PRESSURE OSMOMETERS
Principle:
Standard reference:
Principle: Measurement of dew point (Temperature at which water vapor condenses to a liquid)
Standard reference: NaCl
- test most commonly associated with tubular secretion and renal blood flow
p-aminohippuric acid (PAH) test.
-The inability to produce an acid urine in the presence of metabolic acidosis
- This condition may result from impaired tubular secretion of hydrogen ions associated with the proximal convoluted tubule
- defects in ammonia secretion associated with the distal convoluted
tubule.
RENAL TUBULAR ACIDOSIS
